12034

Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 7.6-12.5 cm

Medicare pricing data for 10,898 providers across 51 states

🤖AI Overview

Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 7.6-12.5 cm (HCPCS code 12034) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $236.34, but hospitals typically charge $800.01 — a 3.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$47.27

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $236.34, your out-of-pocket cost would be approximately $47.27. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$236.34
Average Hospital Charge
$800.01
Markup Ratio
3.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$800.01
Medicare Allowed$236.34
Medicare Payment$184.50

Hospitals charge 3.4x more than what Medicare allows for this procedure. Medicare actually pays $184.50 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$287$8172271+21.6%
Connecticut$285$901123376+20.7%
Alaska$281$1,9262254+18.8%
Hawaii$279$82440106+18.0%
California$272$9618732,528+15.0%
Arizona$256$797234994+8.4%
Massachusetts$256$9843381,161+8.3%
Oregon$255$907138359+8.1%
Florida$253$7439043,072+6.9%
Colorado$252$877197486+6.8%
Maryland$252$698216747+6.7%
Montana$251$63356164+6.1%
New Jersey$248$1,098226512+4.8%
Washington$245$778257770+3.7%
Virginia$243$6373021,560+3.0%
Illinois$243$8673931,116+2.8%
Rhode Island$241$74756219+2.2%
North Carolina$239$6984011,601+1.2%
Utah$238$649114258+0.9%
Georgia$238$7883071,197+0.9%
Pennsylvania$238$6655341,621+0.8%
South Carolina$238$809241898+0.6%
Nevada$236$76670216+0.0%
Texas$236$8206802,024-0.0%
Michigan$233$736323781-1.4%
New York$231$1,0324411,139-2.2%
Wyoming$229$8722088-3.2%
New Hampshire$224$89184376-5.3%
Delaware$224$77949145-5.4%
Nebraska$223$80979254-5.8%
Mississippi$221$669126358-6.3%
Alabama$218$613169554-7.7%
Minnesota$217$970224772-8.1%
Idaho$217$63295381-8.2%
Missouri$216$756253742-8.5%
Tennessee$215$684274990-9.0%
Maine$214$64357169-9.4%
Ohio$213$7723931,071-9.8%
Wisconsin$213$1,173249761-9.9%
Oklahoma$209$742164420-11.4%
Kansas$208$711135533-11.9%
Louisiana$207$734128278-12.5%
Arkansas$206$647114536-12.9%
Indiana$206$777206709-12.9%
Kentucky$205$683175573-13.3%
Iowa$198$929147369-16.4%
New Mexico$194$78051137-17.8%
West Virginia$192$69956212-18.9%
Vermont$185$60742128-21.8%
South Dakota$175$55856153-25.9%
North Dakota$151$5013385-35.9%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

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